Remer Chen, Porat Shay, Levit Lorinne, Amsalem Hagai
Jerusalem Israel Hebrew University School of Medicine, Jerusalem, Israel.
Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
J Perinat Med. 2022 May 11;50(8):1061-1066. doi: 10.1515/jpm-2021-0499. Print 2022 Oct 26.
Although hyponatremia in preeclamptic patients was previously described, its significance remains unknown. We aimed to describe the prevalence and clinical significance of hyponatremia among a cohort of preeclamptic patients.
An electronic medical record based retrospective cohort study included all singleton deliveries at Hadassah University Medical Center between 2003 and 2015. Preeclampsia, with and without severe features, was defined using the American College of Obstetrics and Gynecology (ACOG) Hypertension in Pregnancy Guidelines. Hyponatremia was defined as a sodium (Na) level ≤130 mEq/L, and severe hyponatremia as <125 mEq/L. A group of normotensive pregnant women, matched for gestational age, gravdity and parity, served as control.
A total of 700 preeclamptic patients were identified during the study period. Hyponatremia was noted in 14.6% compared to 0 of 79 patients in the control group. Hyponatremia was strongly correlated with severe features of preeclampsia, adverse neonatal and obstetrical outcome. Severe hyponatremia was strongly correlated with preeclampsia with severe features. Furthermore, even among subgroup of preeclamptic patients without severe features, hyponatremia correlated with less favorable pregnancy outcomes.
Among relatively large cohort of preeclamptic patients, hyponatremia was not a rare finding. We found it more common in patients with preeclampsia and severe features. As women with preeclampsia are at risk for hyponatremia, serum sodium levels should be monitored, especially in those with severe features. In preeclamptic patients without severe features, hyponatremia may indicate a need for closer surveillance. However, larger studies are needed to establish hyponatremia as a marker of severity.
尽管先前已描述过子痫前期患者的低钠血症，但其意义仍不明确。我们旨在描述一组子痫前期患者中低钠血症的患病率及其临床意义。
一项基于电子病历的回顾性队列研究纳入了2003年至2015年间在哈达萨大学医学中心的所有单胎分娩。根据美国妇产科医师学会（ACOG）妊娠高血压指南定义伴有或不伴有严重特征的子痫前期。低钠血症定义为血清钠（Na）水平≤130 mEq/L，严重低钠血症定义为<125 mEq/L。选取一组年龄、孕周、产次匹配的血压正常孕妇作为对照组。
研究期间共识别出700例子痫前期患者。其中14.6%的患者存在低钠血症，而对照组79例患者中无一例出现低钠血症。低钠血症与子痫前期的严重特征、不良新生儿及产科结局密切相关。严重低钠血症与伴有严重特征的子痫前期密切相关。此外，即使在无严重特征的子痫前期患者亚组中，低钠血症也与较差的妊娠结局相关。
在相对较大的子痫前期患者队列中，低钠血症并非罕见发现。我们发现其在伴有严重特征的子痫前期患者中更为常见。由于子痫前期女性存在低钠血症风险，应监测血清钠水平，尤其是伴有严重特征的患者。对于无严重特征的子痫前期患者，低钠血症可能提示需要更密切的监测。然而，需要更大规模的研究来确定低钠血症作为严重程度标志物的地位。
